左束支区域起搏与双心室起搏对心脏再同步治疗预后的影响  

Left bundle branch area pacing versus biventricular pacing for cardiac resynchronization therapy on long-term morbidity and mortality

作　　者：黄珍珍 肖子龙 禹子清 鲍佩 汪菁峰 陈学颖 梁义秀 宿燕岗 葛均波 Huang Zhenzhen;Xiao Zilong;Yu Ziqing;Bao Pei;Wang Jingfeng;Chen Xueying;Liang Yixiu;Su Yangang;Ge Junbo(Department of Cardiology,Zhongshan Hospital,Fudan University,Shanghai Institute of Cardiovascular Diseases,National Clinical Research Center for Interventional Medicine,Shanghai 200032,China;Department of Cardiology,Kashgar Prefecture Second People′s Hospital,Kashgar 844000,China)

机构地区：[1]复旦大学附属中山医院心内科、上海市心血管病研究所、国家放射与治疗临床医学研究中心,上海200032 [2]喀什地区第二人民医院心内科,喀什844000

出　　处：《中华心律失常学杂志》2023年第2期142-147,共6页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的比较左束支区域起搏(LBBAP)与双心室起搏(BVP)对接受心脏再同步治疗(CRT)患者预后的影响。方法本文为回顾性研究。选取2018年2月至2021年3月在复旦大学附属中山医院心内科植入CRT的所有患者, 按照治疗策略将患者分为LBBAP组和BVP组。所有患者在植入后1、3、6个月以及之后每年随访1次。研究的主要终点是全因死亡和心力衰竭住院的复合终点, 次级终点是全因死亡。结果共入选患者324例, 男207例, 女117例, 年龄(64.74±10.35)岁, 中位随访时间为21个月。其中LBBAP组152例, BVP组172例。LBBAP组20例(13.16%, 20/152)、BVP组39例(22.67%, 39/172)患者达到主要终点, 组间差异无统计学意义[log-rankP=0.064, HR=0.61, 95%CI 0.35~1.04, P=0.069];LBBAP组有9例(5.92%, 9/152)、BVP组有16例(9.30%, 16/172)患者达到次级终点, 组间差异无统计学意义(log-rankP=0.398, HR=0.70, 95%CI 0.31~1.60, P=0.401)。多变量Cox回归分析显示, LBBAP组和BVP组之间主要终点和次级终点的风险差异无统计学意义(HR=0.56, 95%CI 0.31~1.00, P=0.051;HR=0.55, 95%CI 0.22~1.38, P=0.204)。结论在接受CRT的患者中, LBBAP对预后的影响与BVP相当。Objective To compare the effects of left bundle branch area pacing(LBBAP)and biventricular pacing(BVP)on the prognosis in patients undergoing cardiac resynchronization therapy(CRT)implantation.Methods In this retrospective study,all patients who received CRT implantation in the Department of Cardiology,Zhongshan Hospital of Fudan University from February 2018 to March 2021,were included.According to the treatment strategy,patients were divided into LBBAP group and BVP group.All patients were followed up at 1,3,and 6 months after implantation and annually thereafter.The primary endpoint was a composite of all-cause death and heart failure hospitalization,and the secondary endpoint was all-cause death.Results A total of 324 patients were enrolled,including 152 in the LBBAP group and 172 in the BVP group.There were 207 males and 117 females,aged(64.74±10.35)years.The median follow-up time was 21 months.The primary endpoint was reached by 20(13.16%,20/152)patients in the LBBAP group and 39(22.67%,39/172)patients in the BVP group[log-rank P=0.064,HR=0.61,95%CI 0.35-1.04,P=0.069].There were 9(5.92%,9/152)deaths in the LBBAP group and 16(9.30%,16/172)deaths in the BVP group(log-rank P=0.398,HR=0.70,95%CI 0.31-1.60,P=0.401).No significant difference was observed in the risk of both the primary and secondary endpoints between LBBAP and BVP groups after multivariate Cox regression analysis(HR=0.56,95%CI 0.31-1.00,P=0.051,and HR=0.55,95%CI 0.22-1.38,P=0.204,respectively).Conclusion LBBAP was associated with comparable effect on long-term prognosis with BVP in patients receiving CRT.

关 键 词：心力衰竭 心脏再同步治疗 双心室起搏 左束支区域起搏 全因死亡 

分 类 号：R541.6[医药卫生—心血管疾病]